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WAL-MART PHARMACY 10-0165
CHC11422-00 MT. ENTERPRISE COMMUNITY HEALTH CLINIC
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Covered Entity Details
Entity Name
MT. ENTERPRISE COMMUNITY HEALTH CLINIC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC11422-00
Entity Address
106 WEST RUSK STREET
MT. ENTERPRISE, TX 75681
Grant Number
H80CS12856
Participating Start Date
10/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0165
Pharmacy Address
2121 HWY. 79 SOUTH
HENDERSON, TX 75654
Pharmacy Comments
Contract Details
Approval Date
1/23/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kenneth A. White, CHIEF EXECUTIVE OFFICER
(903) 822-3076
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/23/2017
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